REPUBLIC OF THE PHILIPPINES

CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

Learning Module

Program: Graduate in Midwifery

Course code: CP 102- Clinical Practicum 2

Module 1

I. Introduction:

The labor room is one of the most versatile rooms in a hospital. It is called a labor, delivery, and
recovery room (LDR). Once you are placed in a room, this is the room that you will use for your labor and
birth, including the initial hours of recovery.
LDR design model accommodates the birthing process from labour through delivery and recovery of
mother and baby within the one room. The room is equipped to handle most small complications.

II. Learning Outcomes:

Developed their understanding of the role and responsibilities on proper donning and doffing
of PPE.
Developed their understanding of the role and responsibilities of the health care provider
during admission to Labor and Delivery.
Recognize nursing intervention in the process of Admission.
Analyze and Interpret admission assessment and its significance.
Identify and Analyze therapeutic drug reaction.

III. Topic and Key Concept

Labor Room & Delivery Room
Personal Protective Equipment
Hand washing
Admission
Admission Assessment
Instruments and equipments
Medication/drugs

IV. Teaching and Learning Materials

Pen and Paper
Oral recitation
Post-test online/offline
Word Format lecture
Reading supplements via link attached
Youtube links
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

VI. Learning Task:

1) Outline the step by step admission process in the labor and delivery room considering the
current situation (Covid-19) 10 pts
2) Identify laboratory and diagnostic exams. Relate its significance. 10 pts
3) Identify (DRAW) the instruments in the mayo tray during delivery and indicate its use.
4) Identify 10 medications in the emergency cart and analyze its therapeutic reactions.

VI. Guidelines for Submission:

1. Submit your accomplished module in the following format:
Any kind of paper (WRITE LIGIBLY)
Word Format
PDF file
Others (offline)

. Submit your accomplished module using the following portal:

Domain email: [email protected]
Facebook messenger
Others (offline)

VI. Learning Evaluation:

 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

DISCUSSION:
Due to spread and impact of COVID-19 in the world lead to fear, stress and anxiety in pregnant mothers.
Hopitals adapted into the situation to accommodate to every needs of expectant mothers and the
pandemic.
The labor room, one of the most versatile rooms in a hospital. It is called a labor, delivery, and recovery
room (LDR). Once you are placed in a room, this is the room that you will use for your labor and birth,
including the initial hours of recovery.
Health Team:
Obstetrician
Midwife
Labor and Delivery Nurse
Neonatologist

In this time of pandemic, health and safety of the midwife and other health care provider can be
compromise. Wearing of PPEs is a must.
PPE acts as a barrier between infectious materials such as viral and bacterial contaminants and your
skin, mouth, nose, or eyes (mucous membranes).
The barrier has the potential to block transmission of contaminants from blood, body fluids, or
respiratory secretions.
Propper DONNING and DOFFING of these PPEs is observed to prevent possible transmission of
infectious maters.
WASH HANDS

Key Times to Wash Hands

Before, during, and after preparing food
Before and after eating food
Before and after caring for someone at home who is sick with vomiting or diarrhea
Before and after treating a cut or wound
After using the toilet
After changing diapers or cleaning up a child who has used the toilet
After blowing your nose, coughing, or sneezing
After touching an animal, animal feed, or animal waste
After handling pet food or pet treats
After touching garbage
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

IN THE LABOR ROOM:

Prior to admission, patient and companion will to undergo initial assessment in the
triage area.
Admission into labor room is only done when the patient is in active labor.

Admission Process: LABOR ROOM

Establishing Therapeutic Relationship
To gain patient and family’s cooperation and trust
The nurse should introduce himself and make them feel welcome. At this point, they
are all anxious and it is best for the nurse to convey his message gently and
confidently. Expectations of the family about birth should be determined and it is
also the best time to ascertain cultural values.

Admission Assessment: All patients admitted or placed in observation to the Labor and
Delivery Unit has an initial assessment including but not limited to:
Biographical data
Name, age, address, date of birth, name of partner ect…
Physical Examination:
Vital signs
Auscultation of heart and lung sounds
Measurement of height and weight.
Fundal height measurement

a. Obstetrical History
Past pregnancy and obstetric history
o OB SCORE
o LMP
o EDC
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

b. Medical History
o Allergies to certain food/medications
o Psychological state
o Past health history and family history

c. Risk factors
o use of tobacco, Alcohol, Illicit drugs
o Diabetes
o Hypertension

d. Fetal status
o FHT
o Position, presentation

e. Labor status including

o Sterile vaginal exam (dilation, effacement, engagement, station)
o Uterine Contraction pattern ( duration, frequency, interval, intensity)
o Membrane status (intact or ruptured, color)

f. Laboratory Studies:
o Urinalysis (UA)
o Complete blood count (CBC).
o Blood typing and Rh factor analysis
o Syphilis screening (RPR)
o Hepa B screening ( HBsAg)

CONSENT FORM MUST BE SIGNED and SECURED

GOWNING
Remove undergarment, jewelries, dentures,
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

First Stage of Labor : Stage of DILATION AND EFFACEMENT

( Divided into three sub-phases, namely: latent, active, and transitional phases.)
CHARACTERISTICS
irregular contractions become progressively coordinated,
discomfort is minimal
and the cervix effaces and dilates to 4 cm.
duration varies, averaging
o 8 hours in nulliparas and 5 hours in multiparas

DON’T!!
a) No routine shaving of the pubic or perineal areas.
b) No routine enemas.
c) Avoid routine induction until 42 weeks.
d) Avoid routine analgesics and anaesthetics, sedatives and tranquillizers.
e) There is no justification for routine amniotomy.
f) No routine intravenous fluids – encourage the mother to drink or eat as she needs.
g) Adopt a “hands off” approach to perineal care: – do minimal vaginal examinations, following
the indications of the partograph – keep hands and fingers out of the vagina – do not “stretch”
the perineaum.

Active Phase
Characteristics:
4 cm cervical dilatation to 7 cm cervical dilatation.
contraction intensity is stronger, interval shortens, and duration lengthens.
true discomfort is first felt by the patient so she is dependent and her focus is on herself.

Nursing responsibilities:
1. Inform patient on the progress of her labor to lessen her anxiety and obtain her trust
and cooperation.
2. Start monitoring progress of labor with the use of WHO partograph, 2-hour action
line.
3. Encourage patient to be continually active to maximize the effect of uterine
contractions. Upright maternal positions are recommended if tolerated.
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

4. Assist patient in assuming her position of comfort. For those who can’t stay upright,
left-side lying is recommended to avoid disruption in fetal oxygenation.
5. Monitor maternal vital signs and fetal heart rate every 2 hours, or depending on the
doctor’s order.
6. Anticipate patient needs (e.g. sponging face with cool cloth, keeping bed clean and
dry, providing ice chips or lip balm) to promote comfort.
7. Determine when patient last voided because a full bladder can hinder fast labor
progress.
8. Institute non-pharmacological pain measures (e.g. breathing exercises, distraction
method, imagery, music therapy, etc.)

Transition Phase
CHARACTERISTICS:
8 cm to 10 cm (full) cervical dilatation
full cervical effacement. During this time
patient may be exhausted and withdrawn or aggressive and restless
Patient’s urge to push is noticeable.

Nursing responsibilities:
1. Inform patient on progress of her labor.
2. Assist patient with pant-blow breathing.
3. Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or
depending on the doctor’s order. Contraction monitoring is also continued.
4. When perineal bulging is noticeable, prepare for delivery. Check room temperature
(25-280C and free of air drafts). The nurse should also notify staff and prepare
necessary supplies and equipment, including resuscitation machine. Lastly, perform
hand washing and double gloving.
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

In the Delivery Room

the perineum is washed and draped.

Second Stage of Labor

Starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. At
this stage, the patient feels an uncontrollable urge to push. The patient may also experience
temporary nausea together with increased restlessness and shaking of extremities. The nurse at
this stage must coach quality pushing and support delivery.

Nursing responsibilities:
1. Instruct patient on quality pushing. The abdominal muscles must aid the involuntary
uterine contractions to deliver the baby out.
2. Provide a quiet environment for the patient to concentrate on bearing down.
3. Provide positive feedback as the patient pushes.
4. Repeat doctor’s instructions. At this phase, the patient barely hears the conversation
around the room because all her energy and thoughts are being directed toward
giving birth.
5. Take note of the time of delivery and proceed to initiate essential newborn care.
Delayed cord clamping is recommended.
6. Assist in restrictive episiotomy for patients who had vaginal birth.

Third Stage of Labor

The placental stage starts from birth of infant to delivery of placenta. It is divided into two
separate phases: placental separation and placental expulsion. Five minutes after delivery of
baby, the uterus begins to contract again, and placenta starts to separate from the contracting
wall. Blood loss of 300-500 mL occurs as a normal consequence of placental separation.
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

Nursing responsibilities:
1. Coach in relaxation for delivery of placenta.
2. Congratulate on delivery of baby.
3. Encourage skin-to-skin contact to facilitate bonding and early breastfeeding
4. Ask patient whether placenta is important to them before it is destroyed. For those
who want to take it home, ensure that they understand and follow standard infection
precautions and hospital policy.
5. Administer prophylactic oxytocin as ordered.
6. Utilize controlled cord traction technique for placental expulsion.
7. mUtilize absorbable synthetic suture materials (over chromic catgut) for primary
repair of episiotomy or perineal lacerations.

Fourth Stage of Labor

Immediate Post-partum period.
Nursing responsibilities:
1. Monitor patients vital signs
2. Monitor any signs of heavy bleeding

Points to Remember:
The delivery service shall be located and arranged to prevent non-related traffic.
The delivery room shall be as remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty areas after changing to surgical
garments.
The nurse station shall be located to permit visual observation of patient movement.
The nursery shall be separate but immediately accessible from the delivery room.
 REPUBLIC OF THE PHILIPPINES
CITY OF OLONGAPO
GORDON COLLEGE
Oval Tapinac Sports Complex, Donor St., East Tapinac, Olongapo City
Tel. nos. (047)224-2088/6929 Telefax no.: (047)224-2089

INSTRUMENTS AND EQUPMENTS:

Labor Room

Fetal Doppler

Oxygen Unit Tank is anchored/chained/

strapped or with tank holder if not pipeline

Improved respiratory outcomes and improved long-term quality of life and lung
function

Patient Bed
with side table

Pulse Oximeter

measures the saturation of oxygen carried in your red blood

cells
 Sphygmomanometer, Non-mercuria &
Stethoscope

Foot stool

Use a
versatile step stool as a handy seat, a place to prop your feet on when
painting your, to be used in place of a visit, consultation, or advice of a
legal, medical, or any other professional.

DELIVERY ROOM
FGFHFHFH1
1. Delivery Set 1/ 2 beds

Surgical steel forceps, with a serrated

2 blunt tip can be used to clamp large
a) Haemostatic/Kelly
blood vessels, manipulate heavy tissue,
Forceps curve or and dissect soft tissue.
straight

Shallow kidney-shaped base, it allows it to held against the patient body to catch
1 all falling debris.
b) Kidney Basin

Made from stainless steel, used to holds

suturing needle during surgical
1 procedures.
c) Needle Holder

1
d) Mayo straight
Used in cutting sutures and Tissue.
 1 It is used
f) Thumb Forceps for grasping and manipulating body tissue. Also used to pack and extract
sponges, pass ligatures and stabilized and, manipulate needles during suturing.

1
g) Tissue Forceps

It is used for grasping and manipulating body tissue. Also used to pack and
extract sponges, pass ligatures and stabilized and, manipulate needles during
suturing

Used to hold the cord in place. Helps stoop

bleeding from the blood vessel in the
umbilical cord. It may stay for several days
while the remaining cord attached to the
1 baby dries.
h) Sterile Plastic
Umbilical Cord

i) Umbilical Cord
Scissors A scissor wide a curved blade in order to effective cut through the umbilical
cord.

2. Delivery Table with

stirrups

Widely used for obstetric birthing, gynecology examination and operation.

3. Emergency
light/Flashlight
 Is a battery-backed lighting device that switches on automatically when a
building experiences a power outage. Emergency lights are standard in new
commercial and high occupancy residential buildings, such as college
dormitories, apartments, hotels and hospital.

4. Foot Stool
Use a
versatile step stool as a handy seat, a place to prop your feet on when painting
your, to be used in place of a visit, consultation, or advice of a legal, medical, or
any other professional.

Are adjustable floor lamps with

bright, directional lighting used for
illuminating exams and treatment
5.Gooseneck/ areas.
Examining Lamps

6. Instrument Table

Surgical instrument tables are sturdy, durable platforms used to hold and
transport all manner of medical supplies, instruments and other equipment

7. Instrument Cabinet

- Cabinet that
holds medicines and toiletries medicine chest.
 8. IV poles, or
intravenous poles

Medical devices designed as a slender iron or aluminum portable pole with

adjustable height, a 4-5 wheeled base for stability, and 2 to 4 hooks on the pole
top that provides a secure place to hang bags of medicine or fluid that with
gravity, ensures an uninterrupted administration

9.Kelly's Pad
A simple
medical device to funnel blood to a collection device in order to help detect
postpartum hemorrhage. The pad is washable and sterilizable, making it far
more cost-effective than a plastic collection drape.

10. Oxygen Unit (w/

humidifier and regulator,
min. 5 lbs) Improved
respiratory outcomes and improved long-term quality of life and lung function

11. Pail

Used during a surgical procedure for the disposal of a number of pliable and
disposable articles, such as sponges that is used to absorb blood or fluids during
the procedure.

12. Stool

Fulfils operating room requirements and ensures you sit comfortably during
procedures
13. Suction Apparatus

Type of medical device that is primarily used for removing obstructions — like
mucus, saliva, blood, or secretions — from a person's airway.

14. Pair of slippers

Prevents the staff and patient from

spreading bacteria and/or acquiring a disease from the floor

15. Room thermometer

Helps maintain the
Desired temperature inside the operating room

16. Gown A personal protective garment intended to be worn by health care personnel
during surgical procedures to protect both the patient and health care personnel
from the transfer of microorganisms, body fluids, and particulate matter.

17. Linen Allow more airflow over your baby's & child's skin than other materials
And helps them keep warm.
 18. Sterile Drapes

Eliminate the passage of microorganisms between nonsterile and sterile areas.

AIR CONDITON 25-28c

1. Emergency Kit or
Cart/portable or trolley 1
(should contain the basic
medicines, equipment and
supplies)
Essential medicines and other items, at all times Having an Emergency Kit is an
important step to prepare for, survive and cope with emergencies.

Emergency Cart Medications

Adenosine 6 mg/2mL vial Digoxin 0.5mg/2mL ampule
Amiodarone 150mg/3mL ampule Diphenhydramine 50mg/mL
ampule
Aspirin USP grade (325 mg/tablet) Dobutamine 250mg/5mL
ampule
Atropine 1mg/ml ampule Dopamine 200 mg/5mL
ampule/vial
Β-adrenergic agonists (i.e. Salbutamol 2mg/ml) Epinephrine 1mg/ml ampule
Benzodiazipine (Diazepam 10mg/2ml ampule and/or Midazolam) (in Furosemide 20mg/2ml ampule
high alert box )
Calcium (usually calcium gluconate 10% solution in 10 mL ampule) Haloperidol 50mg/mL ampule
Clopidogrel 75 mg tablet Hydrocortisone 250mg/2mL vial
D5W 250 mL Lidocaine 10% in 50mL spray
D50W 50mg/vial Lidocaine 2% solution vial
1g/50ml
Magnesium sulfate 1g/2mL ampule Methylprednisolone 4mg/tablet
Mannitol 20% solution in 500ml/bottle Metoclopramide 10mg/2mL
ampule
 Morphine sulfate 10mg/mL ampule (in Nitroglycerin inj. 10 mg/10mL ampule or Isosorbide
high alert box ) dinitrate 5mg SL tablet or 10 mg/10mL ampule
Noradrenaline 2mg/2mL ampule Paracetamol 300mg/ampule (IV preparation)
Phenobarbital 120mg/ml ampule IV or Phenytoin 100mg/capsule or 100 mg/2mL ampule
30mg tablet (in high alert box )
Plain LRS 1L/bottle Plain NSS 1L/bottle – 0.9% Sodium Chloride

Potassium Chloride 40mEq/20mL vial (in Vitamin B1/6/12 vial (1g B1, 1g B6, 0.01gB12 in 10 mL vial)
high alert box )
Sodium bicarbonate 50mEq/50mL ampule Verapamil 5 mg/2 ml ampule

Equipment and Supplies ( E- CART)

Airway adjuncts Gloves, non-sterile
Airway / Intubation Kit ( with stylet and bag valve Laryngoscope with different sizes of blades
masks )
Alcohol disinfectant Nasal cannula
Aseptic bulb syringe Protective face shield or mask or goggles
Calculator Standard face mask
Capillary Blood Glucose (CBG ) Kit Sterile gauze (pre-folded and individually
packed )
Cardiac Board Syringes (different volumes)
Endotracheal Tubes, all sizes Urethral catheter

Flashlights or Pen lights Urine collection bag

Gloves , sterile Waterproof aprons

Reference:
Level 4 PPE in hospital - Bing images
Anatomy of a Delivery Room | Parents
Management of Normal Delivery - Gynecology and Obstetrics - MSD Manual Professional Edition
(msdmanuals.com)
Stages of Labor: Nursing Care Tips for Various Stages (nurseslabs.com)
 The 4 Stages of Labor (verywellfamily.com)
Youtube videos for handwashing, gowning, gloving

Prepared by: Imelda Garachico, RM

Clinical Instructor